Provider Demographics
NPI:1053349480
Name:KHAN, ABDUL Q (MD, MPM)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:Q
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD, MPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2156
Mailing Address - Country:US
Mailing Address - Phone:412-242-8860
Mailing Address - Fax:412-242-8863
Practice Address - Street 1:200 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2156
Practice Address - Country:US
Practice Address - Phone:412-242-8860
Practice Address - Fax:412-242-8863
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058954L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1675081Medicaid
PA1675081Medicaid
PAG32965Medicare UPIN